INVASIVE GROUP-A STREPTOCOCCAL INFECTIONS IN CHILDREN WITH VARICELLA IN SOUTHERN CALIFORNIA

Objective, To describe demographic and clinical features of invasive g roup A streptococcal (GAS) infections in children with varicella in So uthern California in early 1994. Methods, From hospitals of Los Angele s and Orange Counties, children with invasive GAS infections after var icella between January 1 and April 8, 1994, were identified by hospita l infection control nurses. Medical records of patients were reviewed, and any available GAS isolate was further tested, Results, Twenty-fou r cases were identified; 54% were male, 50% were Hispanic and the medi an age was 3 years (range, 0.5 to 8), Four cases died before hospitali zation. The other 20 were hospitalized for a median of 10 days (range, 4 to 50): 14 presented with cellulitis (1 with concomitant epiglottit is), 2 with myositis/necrotizing fasciitis, 2 with pneumonia and 2 wit h bacteremia without apparent source, Five had evidence of multiorgan involvement including two patients fulfilling criteria of streptococca l toxic shock-like syndrome. Of 19 patients with blood cultures, 10 (5 3%) had GAS bacteremia, Onset of GAS infection was suggested, as a med ian, on Day 4 of varicella, with fever, vomiting and localized swellin g being commonly reported, The mean maximum temperature on the day of admission was 39.4 degrees C (102.9 degrees F), Four GAS isolates were M1T1 and one was M3T3, Five isolates produced streptococcal pyrogenic exotoxins A and B. Conclusions, Invasive GAS disease, including strep tococcal toxic shock-like syndrome, is a serious complication of varic ella, Physicians should be alert for the complication of GAS when feve r and localized swelling or signs of cellulitis develop 3 days or more after the onset of varicella, Widespread use of varicella vaccine may decrease invasive GAS infections in this setting.